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Many symptoms that women experience as they age can be related to changes in hormone production by the ovaries, but thyroid and adrenal gland hormone production and function are also very important. There are other abnormal hormone patterns that relate to and exacerbate certain gynecologic disorders such as estrogen dominance, which occurs when a woman does not have normal production and breakdown of hormones to maintain normal hormone levels and normal cycling.

We now have access to very advanced hormone testing to help optimize how hormones behave. Female hormone cycling is an intricately controlled system that includes the hypothalamus, pituitary gland, adrenals, thyroid, and ovarian tissues. This regulation involves negative and positive feedback loops. These tissues are all susceptible to injury or dysfunction, especially by toxic exposure and chronic inflammation, which are often related to lifestyle.

Stress is a major driver and has a profound, direct effect on adrenal function, which can then impact all other systems in the body. A highly processed diet that is high in processed grains, industrial seed oils and sugar is likely to be a problem, as is poor gut health. Many factors impact hormone function over a woman’s lifespan, including environment, genetics, nutrition, physical activity, sleep, mindset, and habits.

Hormone Therapy
There is good evidence to support the value of a comprehensive approach to optimizing feminine health, both in alleviating symptoms and improving function. While hormone therapy became very controversial more than two decades ago, there is good evidence that bioidentical hormone therapy can promote anti aging and be cardioprotective when started soon after the onset of menopause. Hormone therapy provides chemical messages to every tissue in the body to control the actions of cells and organs. It is very effective at relieving moderate to severe menopausal symptoms like hot flashes, night sweats, insomnia, vaginal dryness, urinary symptoms, mood changes and decreased sex drive, while also protecting bones, and heart and brain function as
women age.

Bioidentical hormone replacement therapy is derived from plant sources and comes in various forms, dosages and formulations that can be customized when necessary. All women should consult a well-informed practitioner about this therapy, as well as integrative alternatives that may also be effective at alleviating symptoms. What should result is an individualized approach to hormone health with comprehensive hormone testing and functional blood testing, followed by a detailed discussion about the risks and benefits of bioidentical hormone replacement therapy, in light of the patient’s current health status.

Polycystic Ovary
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder of reproductiveaged women, but it is also associated with metabolic disorders like obesity, diabetes, metabolic syndrome, and gestational diabetes. It is predominantly characterized by irregular menstrual cycles, excessive testosterone, and cystic ovarian changes on pelvic ultrasounds. Women with PCOS also often struggle with infertility, most frequently due to anovulation [the lack or absence of ovulation]. Testosterone excess primarily results from overproduction in the ovary, which may manifest clinically as hirsutism [abnormal growth of facial hair], acne and hair loss (androgenic alopecia), with 60 to 70 percent of those diagnosed affected.

Endometriosis is a condition where tissue similar to the interior lining of the uterus, or endometrium, migrates and implants in areas outside the uterus, primarily in the pelvic region. Sometimes endometrial tissue can be found in more distant locations. These implants respond to monthly fluctuations of a woman’s hormones (estrogen and progesterone) during her menstrual cycle. Estrogen stimulates these implants to grow. The implants may break down and bleed, but there is no exit route for the tissue to leave the body. This leads to painful menstruation, abdominal pain and inflammation that can lead to adhesions, scarring, internal bleeding, bowel or urinary dysfunction, bloating, constipation, painful intercourse, and infertility.

Endometriosis affects 200 million women worldwide and approximately one in 10 women in the U.S. It strikes women from all racial, ethnic, and socioeconomic backgrounds. There is no clear cause and no cure, although it is treatable. There is often a delay in diagnosis as symptoms may initially be minimized. Medical treatment focuses on managing symptoms, with previous standard treatment being birth control pills and pain killers. Newer drug formulations target the hormonal effects of estrogen and progesterone on the implants. In severe cases, surgery may be indicated, however, it is common for it to reappear if not addressed in a fully integrative way.

Uterine Fibroids
Uterine fibroids are very common, affecting approximately 70 percent of women at some point. Many of these cases go undiagnosed because they are asymptomatic. Heavy bleeding or painful menses are the most common symptoms associated with these benign tumors. Women with fibroids report decreased quality of life due to symptoms of bleeding and/or pain, as well as pressure or bulk symptoms if the mass is large, contributing to urinary frequency or constipation. African American women are disproportionately affected, and often at a younger age.

From a functional medicine perspective, fibroids likely indicate some hormonal imbalance, and toxic exposure has been implicated as playing a role in the development of symptoms. Heavy metals, persistent organic pollutants and PCBs have also been correlated with uterine fibroid development. A significant, dose-dependent connection between hair relaxers and fibroid risk also suggests that some African American women may be exposed to more and different chemicals than many white women. Recent data suggests EGCG in green tea has potential to offer some relief of symptoms for uterine fibroids, PCOS and menopause due to its antiangiogenic, antifibrotic and antioxidant properties.

A Functional Approach
Functional medicine takes a more holistic view of these conditions as inflammatory disorders. A typical support protocol will include steps to balance female hormone levels, support hormone detoxification pathways, support the immune system, work on gut health to ensure a balanced microflora (as this directly influences the immune system), remove anything that may be contributing to inflammation (including environmental exposures) and place patients on an anti-inflammatory diet and supplements. Other lifestyle measures are incorporated to manage stress and sleep and minimize toxic exposure.

Regular Maintenance
All women should have regular checkups and functional lab testing to be evaluated for possible nutrient deficiencies, metabolic dysfunction, inflammation, abnormal thyroid or adrenal function, or toxicity, as well as comprehensive hormone testing to identify and address any underlying imbalances and correct them. These will likely include lifestyle and dietary changes to shed any excess weight gained while rebalancing hormones.

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